Mortality prediction after major surgery in a mixed population through machine learning: a multi-objective symbolic regression approach.

Introduction: Understanding 1-year mortality following major surgery offers valuable insights into patient outcomes and the quality of peri-operative care. Few models exist that predict 1-year mortality accurately. This study aimed to develop a predictive model for 1-year mortality in patients undergoing complex non-cardiac surgery using a novel machine-learning technique called multi-objective symbolic regression.

Multiomic molecular patterns of lipid dysregulation in a subphenotype of sepsis with higher shock incidence and mortality.

Background: Lipids play a critical role in defense against sepsis. We sought to investigate gene expression and lipidomic patterns of lipid dysregulation in sepsis.

Methods: Data from four adult sepsis studies were analyzed and findings were investigated in two external datasets.

Effects of two different dexamethasone dosing regimens on ventilator-free days and long-term mortality in COVID-19 patients with moderate-to-severe ARDS: the REMED randomized clinical trial.

Background: Dexamethasone 6 mg in patients with severe COVID-19 has been shown to decrease mortality and morbidity. The effects of higher doses of corticosteroid, that would further increase anti-inflammatory effects, are uncertain. The objective of our study was to assess the effect of 20 mg dexamethasone vs.

Preoperative activation of the renin-angiotensin system and myocardial injury in noncardiac surgery: exploratory mechanistic analysis of the SPACE randomised controlled trial.

Background: Hypertension therapy in older adults is often suboptimal, in part because of inadequate suppression of the renin-angiotensin-aldosterone system (RAAS). We hypothesised that distinct endotypes of RAAS activation before noncardiac surgery are associated with increased risk of myocardial injury.

Methods: This was a prespecified exploratory analysis of a multicentre randomised controlled trial (ISRCTN17251494) which randomised patients ≥60 yr old undergoing elective noncardiac surgery to either continue or stop RAAS inhibitors (determined by pharmacokinetic profiles).

Coffee Consumption Correlates With Better Cognitive Performance in Patients With a High Incidence for Stroke.

Background: Atrial fibrillation is an independent risk factor for the development of cognitive impairments. Regular coffee consumption has shown cognitive benefits in healthy individuals. Whether regular consumption reduces cognitive decline in vulnerable patients is controversial.

Early Restrictive vs Liberal Oxygen for Trauma Patients: The TRAUMOX2 Randomized Clinical Trial.

Importance: Early administration of supplemental oxygen for all severely injured trauma patients is recommended, but liberal oxygen treatment has been associated with increased risk of death and respiratory complications.

Objective: To determine whether an early 8-hour restrictive oxygen strategy compared with a liberal oxygen strategy in adult trauma patients would reduce death and/or major respiratory complications.

Design, Setting, And Participants: This randomized controlled trial enrolled adult trauma patients transferred directly to hospitals, triggering a full trauma team activation with an anticipated hospital stay of a minimum of 24 hours from December 7, 2021, to September 12, 2023.

Effects of very early hyperoxemia on neurologic outcome after out-of-hospital cardiac arrest: A secondary analysis of the TTM-2 trial.

Purpose: Hyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear.

Methods: The secondary analysis of the Target Temperature Management 2 (TTM-2) randomized trial.

Exchange rates of second generation Microcuff® pediatric endotracheal tubes in children weighing more than 3 kg : A retrospective audit.

Background: Cuffed endotracheal tubes (cETT) pose the potential advantage of an infrequent need for reintubation in pediatric patients compared to uncuffed tubes. The aim of this study was to investigate tube exchange rates using second generation Microcuff® pediatric endotracheal tubes (PET) with an adapted sizing recommendation in a large single institution cohort of children and to identify potential variables associated with an elevated risk of tube exchange.

Methods: Patient data obtained from the electronic patient data management system of the Department of Anesthesia, University Children's Hospital Zurich, Switzerland, were retrospectively assessed for demographic and anthropometric information, size of the internal tube diameter used for positive pressure ventilation and divergence from the size recommendation chart.

Mortality in septic patients treated with short-acting betablockers: a comprehensive meta-analysis of randomized controlled trials.

Background: Treatment with short-acting betablockers in septic patients remains controversial. Two recent large multicenter trials have provided additional evidence on this therapeutic approach. We thus performed a meta-analysis, including the most recent data, to evaluate the potential impacts of treatment with short-acting betablockers on mortality in adult septic patients.

Antibiotic-Induced Immunosuppression-A Focus on Cellular Immunity.

Antibiotics are the fundamental treatment for bacterial infections. However, they are associated with numerous side effects. Their adverse effects on the immune system are increasingly recognised, with several mechanisms identified.

Eye tracking during a simulated start of shift safety check: An observational analysis of gaze behavior of critical care nurses.

Background: The handover and associated shift start checks by nurses of critical care patients are complex and prone to errors. However, which aspects lead to errors remains unknown. Fewer errors might occur in a structured approach.

Sepsis: key insights, future directions, and immediate goals. A review and expert opinion.

This review explores the current landscape and evolving understanding of sepsis, highlighting both challenges and future directions. Sepsis remains a major global health burden, with diverse clinical presentations complicating timely diagnosis and management. Existing definitions, including the Sepsis-3 criteria, emphasize the importance of organ dysfunction, yet early sepsis detection remains limited by available tools.

Prehospital ultrasound constitutes a potential distraction from the observation of critically ill patients: a prospective simulation study.

Background: Prehospital point-of-care ultrasound allows an unstable patient to be rapidly and accurately assessed. However, we are concerned that an excessive focus on the ultrasound device, in an already demanding emergency medical service environment, may distract from patient care, potentially leading to reduced situational awareness and the neglect of other crucial instruments, such as the patient monitor. Thus, in this study, we examined the influence of prehospital ultrasound on situational awareness, by studying the degree to which physicians were distracted from the patient monitor.

Marked hemoglobin mass expansion and plasma volume contraction in Sherpas acclimatizing to 5,400 m altitude.

In lowlanders, high altitude (HA) acclimatization induces hemoconcentration by reducing plasma volume (PV) and increasing total hemoglobin mass (Hb). Conversely, Tibetan highlanders living at HA are reported to have a similar hemoglobin concentration ([Hb]) as lowlanders near sea level, and we investigated whether this reflects alterations in the PV or the Hb response to HA. Baseline assessment of PV and Hb was performed by carbon monoxide rebreathing at low altitudes (∼1,400 m) in Sherpas (an ethnic group of Tibetans living in Nepal) and native lowlanders.

Effect of therapeutic plasma exchange on tissue factor and tissue factor pathway inhibitor in septic shock.

Background: Coagulopathy is part of the pathological host response to infection in sepsis. Higher plasma concentrations of both tissue factor (TF) and tissue factor pathway inhibitor (TFPI) are associated with occurrence of disseminated intravascular coagulation (DIC), multi-organ dysfunction and increased mortality in patients with sepsis. Currently no treatment approaches specifically targeting this axis are available.

A Longitudinal Model for a Dynamic Risk Score to Predict Delayed Cerebral Ischemia after Subarachnoid Hemorrhage.

Background: Accurate longitudinal risk prediction for DCI (delayed cerebral ischemia) occurrence after subarachnoid hemorrhage (SAH) is essential for clinicians to administer appropriate and timely diagnostics, thereby improving treatment planning and outcome. This study aimed to develop an improved longitudinal DCI prediction model and evaluate its performance in predicting DCI between day 4 and 14 after aneurysm rupture.

Methods: Two DCI classification models were trained: (1) a static model based on routinely collected demographics and SAH grading scores and (2) a dynamic model based on results from laboratory and blood gas analysis anchored at the time of DCI.

Impact of the COVID-19 Pandemic on Group A Streptococcal Necrotizing Soft Tissue Infections: A Retrospective Cohort Study.

Background: Necrotizing soft tissue infections (NSTIs) are often caused by group A (GAS). As the number of invasive GAS infections decreased during the coronavirus disease 2019 (COVID-19) pandemic restrictions, this study aimed to compare the occurrence of GAS-NSTIs before, during, and after the COVID-19 pandemic restrictions.

Methods: This retrospective cohort study included adult patients with NSTIs admitted to the intensive care unit (ICU) of the University Hospital Zurich, Switzerland, from July 2008 to December 2023.

ECMO support may be associated with improved survival in tuberculosis associated severe ARDS.

Background: Data describing outcome of extracorporeal membrane oxygenation (ECMO) support in Tuberculosis (Tbc)-associated acute respiratory distress syndrome (ARDS) remain sparce and are mostly confined to singular case reports. The aim of this case series was to analyze intensive care unit (ICU) survival in patients with Tbc-associated ARDS receiving veno-venous (vv-) ECMO support and to compare those to patients not receiving ECMO.

Case Presentation: ICU survival was analyzed retrospectively in 14 patients treated for Tbc-associated ARDS at three ECMO-referral university hospitals (Hannover Medical School, University Hospital Bonn (both Germany) and University Hospital Zurich (Switzerland)) during the last 14 years, of which eight patients received additional vv-ECMO support and six standard care only.

Extracorporeal cytokine adsorption as therapeutic option for immune effector cell-associated neurotoxicity syndrome.

With the rising number of patients receiving chimeric antigen receptor T-cells, the treatment of this therapy's complications is of growing concern to intensivists and neurologists. We used extracorporeal cytokine adsorption as an add-on therapy in a patient suffering from immune effector cell-associated neurotoxicity syndrome. Interleukin-6 level, which as a readily available parameter is generally used to evaluate course of disease, was rapidly reduced using this method.